MEDICARE: AUTHENTIC PATH THERAPY AND CONSULTATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1710556824
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUTHENTIC PATH THERAPY AND CONSULTATION

Provider Business Mailing Address
First Line	:	3327 CROWE HILL CIR
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-5933
Country	:	US
Telephone Number	:	573-587-4663
Fax Number	:	314-648-8814

Provider Business Practice Location Address
First Line	:	3327 CROWE HILL CIR
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-5933
Country	:	US
Telephone Number	:	573-587-4663
Fax Number	:	314-648-8814

Authorized Official
Title or Position	:	OWNER
Name	:	JENNIFER GRIER
Credential	:	LCSW
Telephone Number	:	573-587-4663

Provider Enumeration Date	:	06/22/2021
Last Update Date	:	01/08/2025

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